Mitigating Existential and Spiritual Distress: PART II Signs & Symptoms

CAUSES, SYMPTOMS, SIGNS OF EXISTENTIAL & SPIRITUAL DISTRESS

EXISTENTIAL & SPIRITUAL CONCERNS

•      Identity - unclear sense of who I am and how one fits into the world, conflicts between the self and different aspects of oneself as it relates to others (Relatedness).

•      Freedom - Blurred or confusing boundary between the experience of free will and the external forces and the complex array of alternatives (Autonomy).

•      Isolation -a longing need to feel and be connected, versus the experience of not being seen or known (Desires).

•      Meaning - the desire to believe in a life that is meaningful versus the events and experiences that appear to be random and inconsistent with one's belief.

•      Death - awareness of its inevitability, and desire for continued existence.

WHAT IS EXISTENTIALISM

"A physiological inquiry that explores the problem of human existence and centers on the subjective experience of the person's thinking, feeling, and acting. It explores the meaning, purpose, and value of human existence where the human person is compelled to find or create their own sense of meaning and purpose in a meaningless world to achieve selfhood. " Wikipedia

EXISTENTIAL CONTEXT (KS)

Is one's search for meaning to make sense of one's life events, relationships, and oneself within one's subjective experience, perceptual outlook, comprehension, and interpretation of their world.

Implicit in the question(s) is what it is to be human?

1. Who am I? (now, then, future)

2. What is my purpose?

3. Where am I going

4. What is the meaning of life?

5. Making sense of it all

6. When not making sense of it all

7. Angst , Suffering.

 Note: Principle & Foundation of St. Ignatius

SPIRITUALITY DEFINED (KS)

Today Spirituality is defined as one expression of one's beliefs and values in which they find meaning and purpose. It is most often associated with having a sense of connection to something larger than oneself such as a family, community, nature, or a transcendent being*.

The expression and meaning may be found in a community in the form of organized religion with its set of beliefs, and expectations in behaviors, rites, and rituals. For examples: a personal relationship with a transcendent divinebeing in the Abrahamic monotheistic traditions: 

YHWH(G_d), Triune God (Abba, Jesus, Spirit) or Allah; or in a philosophical tradition nontheistic such as Buddhism or multi theistic such as Hinduism.

Meaning may be found in an individual expression through what one loves such as art or music or one's vocational mission, or one’s own experience of something transcendent that can include a desire for an attachment to a transcendent energy (the Universe, Other, Higher Power), or not (no transcendent ‘entity’ exists).

Overall is it now considered what are the connections that are expressed which provide a sense of comfort, peace, guidance, and a source of strength – way of being in the world, a way of proceeding in the world.

CAUSES, SYMPTOMS, AND SIGNS OF EXISTENTIAL DISTRESS

WHAT IS EXISTENTIAL DISTRESS?

Is when one is unable to find answers to their questions on the meaning and purpose of their life. It can range from areas such as uncertainty about their life goals, their identity, or more seriously the meaning of their existence in viewing it in a meaningless world.

The essential question surrounding existential crisis is whether or not there is any pre-existing meaning to a person's life or life itself.

WHY IS IT TRIGGERED OR WHEN CAN IT OCCUR?

An event that changed one's life such as coming to terms with what's mortality or confronting a life-threatening illness.

SYMPTOMS

•  Emotional Symptoms: Feeling of helplessness, or despair, vulnerability, fear, loneliness, anxiety, not feeling true to oneself. Feeling disconnected from oneself and others in the world.

•      Cognitive symptoms: Thinking that life has lost its purpose, thinking that one has lost their values, or ideas about oneself, negative thoughts, regret, disappointment

•      Longing for a ground in a world that seems groundless. Seeking stability.

SIGNS

•      Breaking off relationships, substance-abuse, antisocial behavior.

•      Blocking off emotions or feelings that they struggle with.

•      Difficulty in making decisions

•      Anxiety, Sleep Disturbance

•      Loss of interest in daily activities

OVERCOMING AN EXISTENTIAL CRISIS

•      Breaking down the larger questions into smaller chunks.

•      Keeping a gratitude journal, reflecting on the daily interactions of positive experiences.

•      Become aware of negative thought patterns seeking help to reduce the negative self-talk.

•      Reconnected or reconnecting with loved ones.

•      Redirecting energy to other activities.

CAUSES, SYMPTOMS, AND SIGNS OF SPIRITUAL DISTRESS

WHAT IS SPIRITUAL DISTRESS

Spiritual distress, as in Existential distress, occurs when a person is no longer able to find meaning, peace, comfort, strength, and or connections in their life.

Spiritual distress can be characterized by an expression of a deficit of meaning, purpose, hope, forgiveness, and or intimacy with the divine; and or anger or lack of interest in previously spiritually or religiously nourishing activities.

SPIRITUAL DISTRESS A DEFINITION

"Spiritual distress has a nursing diagnosis (NANDA International) of impaired ability to experience and integrate meaning and purpose in life through the individual's connectedness with self, others, art, music, literature, nature, or a power greater than oneself.7 This definition corresponds well with the consensus definition of spirituality: spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.8" https://www.jpsmjournal.com/article/s0885-3924(17)30187-2/fulltext

CAUSES OF SPIRITUAL DISTRESS

•      Broken relationships - with family, community, or the Transcendent (Other) as they understand and believe

•      Loss of Meaning/Purpose - with one's health, work

•      Shame/Guilt/ Forgiveness - from others upon them; from themselves upon themselves, or on others, or the Other; restoration

•      Hopelessness - due to helplessness

SYMPTOMS (KS)

•      Feeling a loss of hope, empty, directionless

•      Sense of failure to live within one's beliefs or the precepts of one's faith.

•      Feelings of abandonment (by their High Power)

•      Fear related to apprehension about the soul's future after death

•      Anxiety from feeling they are not sufficiently prepared for death

SIGNS (KS)

•      Sleep Disturbance

•      Anxiety/Depression

•      Changes in religious or spiritual practices

•      Expressing disappointment in one's current belief system

•      Questioning the credibility of their belief system

•      Demonstrating discouragement or despair

•      Inability to practice through usual religious rituals.

•      Decisional conflict - between the treatment plan and current versus past beliefs

•      Expressing concern, anger, resentment, fear, over the meaning of life suffering and death

•      Lethargy or lack of interest

•      Outbursts

STATEMENTS

Spiritual Pain of Relatedness - My family has forgotten me

Spiritual Pain of Meaning - My life has no purpose

Spiritual Pain of Forgiveness - My life is full of shame and guilt

Spiritual Pain of Forgiveness Hopelessness - I just want to die here

Asking questions about pain and suffering - Why is God doing this to me?" "Why is God allowing me to suffer?" "Where is God?”

Spiritual Direction in the Journey of Illness

This series is intended for spiritual directors who accompany individuals facing life-altering illnesses, as well as those who serve as caregivers. It draws from presentations I have given to spiritual direction interns, nursing students, and parishioners involved in ministry to the sick and homebound. The content is shaped by my background in family practice as a chiropractic physician, my years of service as an on-call chaplain at Yale New Haven Health, and my work as a patient advocate and spiritual director accompanying individuals through illness and suffering.

Reflection Questions

Identity, Meaning, and Purpose

1. When accompanying someone who has indicated they lost their sense of identity or purpose, what interior movement do you notice within yourself, remembering that each person is made in God's image and likeness and has inherent dignity (Genesis 1:27)?

   
   

2. How have you, or how might you, discern when a directee’s longing for meaning is being expressed in disguised forms—such as anger, apathy, or perfectionism?

   Consider this in light of the belief that God created us for Himself, and our hearts are restless until they rest in Him (St. Augustine, Confessions).

   
   

3. In what ways has your understanding of your own purpose changed when you are given someone to accompany who is journeying through suffering, considering that we are called to be the hands and feet of Christ, serving others in their need (Matthew 25:40):

   “Truly I tell you, whatever you did to one of the least of these brothers of mine, you did to me.”

Isolation, Alienation, and Relatedness

4. How have you created a space for someone to be seen and not feel alone, even when their suffering is beyond your comprehension, recalling Jesus's presence with the marginalized and isolated (Luke 15:1-2):

   “Now the tax collectors and sinners were all gathering around to hear Jesus. But the Pharisees and the teachers of the law muttered, ‘This man welcomes sinners and eats with them.’”

   
   

5. Reflect on a time when you felt spiritually isolated. What helped you move toward reconnection—with God, others, or yourself, remembering that nothing can separate us from the love of God (Romans 8:38-39): “For I am convinced that neither death, nor life, nor angels, nor principalities, nor present things, nor future things, nor powers, nor height, nor depth, nor any other creature will be able to separate us from the love of God in Christ Jesus our Lord.”

   
   

6. Where have you experienced or seen the silence of grief in lost relationships—whether with others or with God, recognizing that grief is a natural response to loss, and God is close to the brokenhearted (Psalm 34:18):

   “The righteous cry out, the LORD hears and he rescues them from all their afflictions.”

Mortality and Fear of Death

7. How do you see Jesus accompany someone who is facing their mortality without bypassing their fear or offering premature reassurance, remembering that Jesus wept at the death of Lazarus (John 11:35 And Jesus wept.) and faced His own death with courage and trust?

   
   

8. What personal beliefs or assumptions you have about death influence the way you listen to a dying person or someone grieving, considering the Church's teaching on death, judgment, heaven, and hell (CCC 1020–1060)? https://www.catholiccrossreference.online/catechism/#!/search/1020-1060

   
   

9. When someone expresses fear about their soul or eternal life, what words would feel would be Blessed Mother response to this person in her gentleness and truth, recalling her role as a compassionate intercessor and her words at the Wedding at Cana?  (John 2:5 5 His mother said to the servers, “Do whatever he tells you.”)

   
   

Signs of Distress: Interior Listening

10. What emotional, behavioral, or spiritual “signs” have you learned to attend to as invitations—not problems to fix, recognizing that the Holy Spirit speaks in whispers and that attentive listening is essential (1 Kings 19:12):

    “After the earthquake, fire—but the LORD was not in the fire; after the fire, a light silent sound."

    
    

11. How do you respond when a directee shows anger toward God or despair about life? What helps you remain rooted in hope, remembering that God can handle our anger and doubt, and that hope is an anchor for the soul (Hebrews 6:19):

    “This we have as an anchor of the soul, sure and firm, which reaches into the interior behind the veil, where Jesus has entered on our behalf as forerunner, becoming high priest forever according to the order of Melchizedek.”

    
    

12. How would you discern the difference when a directee’s withdrawal or disinterest in spiritual practices is a signal of deeper suffering rather than a loss of faith, considering that spiritual dryness can be a part of the journey, and perseverance is key? (CCC 2731):

    “Another difficulty, especially for those who sincerely want to pray, is dryness. Dryness belongs to contemplative prayer when the heart is separated from God, with no taste for thoughts, memories, and feelings, even spiritual ones. This is the moment of sheer faith clinging faithfully to Jesus in his agony and in his tomb. ‘Unless a grain of wheat falls into the earth and dies, it remains alone; but if it dies, it bears much fruit.’”

    “If dryness is due to the lack of roots, because the word has fallen on rocky soil, the battle requires conversion.”

The Director’s Interior Landscape

13. When someone questions the credibility of their belief system or expresses spiritual pain, what part of your own story is stirred, recognizing that we are all wounded healers, and our own experiences can inform our compassion (2 Corinthians 1:3-4):

    “Blessed be the God and Father of our Lord Jesus Christ, the Father of compassion and God of all encouragement, who encourages us in our every affliction, so that we may be able to encourage those who are in any affliction with the encouragement with which we ourselves are encouraged by God.”

    
    

14. What spiritual disciplines or resources help you hold space for others without absorbing theirs anguish, remembering the importance of prayer, self-care, and setting boundaries (Mark 1:35):

    “Rising very early before dawn, he left and went off to a deserted place, where he prayed.”

    What images come up for you as you go off to the deserted place of having Jesus or Mary take their suffering to the Father?

    
    

15. Where is the Holy Spirit inviting you to grow in humility, courage, or silence as you accompany others in distress, considering that spiritual direction is guided by the Holy Spirit, and we are called to be docile instruments?

    Which fruits of the Spirit have been growing in you? (Galatians 5:22-23):

    “The fruit of the Spirit is love, joy, peace, patience, kindness, generosity, faithfulness, gentleness, self-control. Against such there is no law.”

Part I: Introduction & Definitions

Part II Signs & Symptoms

Part III Listening & Assessment

Part IV The Narrative

Part V Human Development

Part VI Offering Scriptures

*This 6-Part Series is for spiritual directors who accompany individuals facing life-altering illnesses, as well as those who serve as caregivers. It draws from presentations I have given to spiritual direction interns, nursing students, nurses, and parishioners involved in ministry to the sick and homebound. The content is shaped by my background in family practice as a chiropractic physician, my years of service as an on-call chaplain at Yale New Haven Health, and my work as a patient advocate and spiritual director accompanying individuals through illness and suffering, and years of collecting notes from various sources. I take no personal credit for the work as original.